A & S Medical, P.C. v. Allstate Insurance Co

In A & S Medical, P.C. v. Allstate Insurance Co., 196 Misc 2d 322, (AT 1st Dept. 2003) the court, in passing on blanket disclaimers, stated as follows: "Although defendant argues otherwise, its belated denial of plaintiff's no-fault claim is not properly 'deemed' timely on the basis of its earlier blanket disclaimer of responsibility to reimburse plaintiff's assignor for further orthopedic treatment, a disclaimer which predated plaintiff's rendition of the services billed for and the filing of plaintiff's claim form. 'When a provider of medical services submits a claim as assignee of an insured, neither the statute nor the regulations contemplates the insurer simply sitting mute and failing to act upon the claim, silently and secretly relying upon an earlier denial issued directly to the insured.' The contrary construction urged by defendant effectively authorizing the sub rosa denial of properly filed no-fault claims is inconsistent with the plain language of Insurance Law 5106(a) and, if adopted, would serve to vitiate the so-called 30-day rule embodied in 11 NYCRR 65.15(g)(3) and to undermine a core objective of the no-fault scheme 'to provide a tightly timed process of claim, disputation and payment." (at p. 323-324).